Atheromatous degeneration of the neointima in a bare metal stent: intravascular ultrasound evidence.

We report intravascular ultrasound evidence of a ruptured plaque within a bare metal stent restenosis. In the traditional view, in-stent restenosis is considered to be a benign condition associated with progressive apposition of inert extracellular matrix. The clinical correlate of this pathology would be stable angina. In contrast, recent data have shown that at least one-third of patients with in-stent restenosis present with acute coronary syndromes. This case provides in-vivo evidence that the neointima can undergo atheromatous degeneration and rupture. This matches evidence from recent registries and in-vitro data suggesting that bare metal stent restenosis should not be considered a clinically benign entity.